Ketamine Treatment for PTSD

There are many treatments for PTSD available to you. They include:

• Trauma-focused therapies such as Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), Eye Movement Desensitization and Reprocessing (EMDR), and others
• Antidepressants such as SSRIs and SNRIs
• Emotionally Focused Therapy (EFT)
• Psychotherapy approaches such as Cognitive Behavioral Therapy (CBT) and others
• Complementary and Alternative Methods (CAMs) such as yoga, acupuncture, meditation, and other treatments.

Your physician or mental health specialist prescribes the best treatments to help you get back to a good daily quality of life.

Patients who may be appropriate for ketamine treatment for PTSD have tried some of these other treatments already. They haven’t worked well enough, aren’t working fast enough, or aren’t working at all. ketamine is another treatment available to you.

Ketamine treatment for PTSD offers benefits many other treatments do not. For patients who respond well to treatment, the biggest benefit is how fast ketamine works. Numerous studies have shown that patients can have a rapid relief in symptoms. More studies are underway.

Overall, about 70% - 75% of patients who get Ketamine treatment for anxiety experience positive results. Different studies report different success rates. Like any treatment for PTSD, not all patients will have positive results. It’s also important to know that ketamine isn’t a cure for PTSD, but rather an adjunct to improve your current therapy; it’s a better way to help you overcome your PTSD.

Ketamine, an anesthetic that’s been used since the 1960s, was found to have unexpected and profoundly beneficial psychological effects. In general anesthesia, the goal is to put the patient to sleep. Compared to a hospital setting, patients with depression receive ketamine at a much lower dose over a shorter period of time. The infusion is controlled and can be tapered down to the patient’s needs.

Ketamine is given intravenously while the patient is on a cardiac monitor to continually assess their vital signs. Patients receiving ketamine treatment for PTSD often describe the feeling as floating, or an out-of-body, “loopy” experience. Short term side effects are feelings of dissociation of mind and body, disorientation, and visual hallucinations. Patients can wear an eye mask during treatment to avoid any visual disturbance. Some patients may feel a temporary numbness to hands, feet, and around the mouth. Some patients may feel nauseated toward the end of a treatment. Some patients may have an elevation in their blood pressure and heart rate. This is usually transient and resolves after the infusion is finished.

Each patient must have documentation of their diagnosis of PTSD from a qualified mental health professional. The first step is for the patient to complete diagnostics for PTSD, depression, anxiety, drug abuse, and alcohol abuse before a medical screening exam. All test results are shared with the patient’s providers.

The next step is for the patient to complete a medical exam with Dr. Manno. Dr. Manno will review the patient’s medical history and discuss what to expect during the treatment experience.

The induction phase of ketamine treatment for PTSD is two infusions per week for two weeks. For each treatment, the patient will receive a slow intravenous infusion starting at 0.5 mg/kg of ideal body weight. If the patient has little response to the initial treatment, the dosage will be increased up to a maximum of 0.75 mg/kg ideal body weight.

Each infusion lasts 45 minutes; after that it takes about another 45 minutes for the patient to feel back to normal. Patients must arrange to have someone take them home after treatment.

Patients will need periodic infusions of ketamine to maintain the therapeutic effects. Frequency of maintenance infusions will depend upon patient response. Each patient is unique and the treatment regimen will be determined by the physician.

Oral ketamine

We offer ketamine as a lozenge, or troche, for home use after the induction phase is finished. Patients can take oral ketamine up to twice a week as needed for their symptoms. The lozenge, compounded at a local pharmacy, is allowed to dissolve in the mouth. It’s a much smaller dose than IV ketamine and can help increase the time between booster infusions.

Patients interested in oral ketamine will need medical screening with Dr. Manno prior to receiving a prescription.

After the two weeks of treatment have been completed, patients will take the same diagnostic tests given before the Induction Phase. We do this to compare patient responses to their baseline and measure the effectiveness of treatment. All results will be shared with the patient’s providers.

Patients with uncontrolled hypertension, severe heart disease, active psychosis, or in a manic phase of bipolar disorder, or are taking methamphetamines, cocaine or other stimulants should not receive ketamine treatment. Patients who are chronically taking benzodiazepines, such as xanax, valium, ativan, can have a blunted response to ketamine, and should have their mental health professional or primary physician see if they can decrease their dosage prior to treatment.

Research into Ketamine treatment for PTSDis ongoing. Here is a sample of studies published and available to the general public or through a PubMed subscription

Feder, Parides et al.  “Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial.”  JAMA Psychiatry. 2014 Jun;71(6):681-8.

Liriano, Hatten, et al. “Ketamine as a treatment for post-traumatic stress disorder: a review” Drugs in Context 2019; 8:212305. DOI: 10.7573/dic.212305